Marketing Model for MIS in Rural Areas


  • Lancet Commission on Global Health estimates the need for surgical procedures in rural areas as 5,000 per 100,000 population every year
  • About 1,200 of these could be carried out laparoscopically [1]
  • Another 300 to 500 of these could be managed by endoscopic methods [2] mostly urological problems.
  • Regular diagnostic and surgical camps offer the most cost–effective way of managing surgical problems in rural areas [3]
  • Minimally invasive surgeries are appropriate for rural areas [4] for a variety of reasons
  • The market penetration of laparoscopic surgeries are only about 10% at present and might just double in another few years and the reasons are primarily related to the coordination of getting general anesthesia and gases in rural areas and the high costs and steep learning curve [4,5]


  1. Opens a market not penetrated by classic MIS-like conventional laparoscopic surgeries and endoscopic surgeries that is about ten times the current market for MIS
  2. MIS makes surgeries possible with regular visiting teams thus making it the most cost-effective method of surgical care delivery
  3. They are attractive to rural patients because of less pain and capability of getting back to work earlier and the same factors help them to pay more as they lose less due to time spent at the hospital

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  1. To develop a replicable model to carry out about 2,000 MIS procedures every year for a population of 100,000
  2. To work out methods of exponential growth


A population of 100,000 will have about four surgical facilities that are standardized who share human resource and equipment and carry out about 2,000 MIS every year.

The various steps involved are

  1. Identification of these surgical facilities
  2. Standardization of these surgical facilities
  3. Training of the workforce at these facilities
  4. Work out a win–win collaboration for all stakeholders involved


For a successful model, there are some pre-requisites conditions that are necessary

  1. MIS should be possible under spinal anesthesia or regional anesthesia and without the need for bottled gases
  2. The training program should be at the workplace and should not displace the existing workforce
  3. The costs should be low


    • Sponsor studies on gasless laparoscopic surgeries and endoscopic surgeries for renal stones and vaporization surgeries for prostate
    • Sponsor skills lab to teach the skills of gasless laparoscopic studies
    • Sponsor innovation competitions and visits to rural area surgical facilities
    • Upgrading the gasless laparoscopic surgery equipment
    • Low cost camera system for gasless laparoscopic surgeries
    • Low cost vessel sealing and underwater vaporization surgeries cautery machine
    • Low cost post-operative monitoring system
    • Develop courses like spinal anesthesia for medical officers, gasless surgeries for rural surgeries, endoscopic urology surgeries for rural surgeons, etc., with online – onsite training programs
    • Use mobile surgical teams to do the training
    • With expansion use the volunteer base of trained surgeons [similar to the assessor workforce of NABH] for training and credentialing
    • Formation and initial training of groups of surgical facilities to take care of the surgical needs in populations of about 100,000
    • Developing a human resource and equipment sharing model


There are several sources of revenue in this model that makes it sustainable

  1. TRAINING PROGRAMS: When the advantages of the MIS are known to the public there would be a great demand for the training programs. There are significant advantages like the following
    1. There are no complications of conventional laparoscopic surgery. Although small there are definite complications associated with conventional laparoscopic surgeries [6]
    2. There is no physiological changes associated with carbon di oxide insufflation that becomes significant when the surgery is prolonged
    3. The costs are much less compared to conventional laparoscopic surgeries
    4. Recovery is faster and single incision surgeries are much less expensive with gasless laparoscopic surgeries
    5. The endoscopic urologic surgeries are carried out through normal urinary passage and hence much less invasive and safer
  2. TRAINING AND CREDENTIALING: The innovative online – onsite training programs are popular as they do not take the person away from their work and are more relevant to the local needs of the place. The trainees can afford to pay more as they need not pay for accommodation and shifting to the new place and would not lose their income during the training period
  3. THE REGULAR SURGICAL CAMPS: The experience at SEESHA [7] and at Burrows Memorial Christian Hospital [3] is that these are financially viable model despite making it affordable for the poor and are able to meet more than half the estimated surgical needs of large geographical areas. During the training period the local facilities pay for
    1. The travel and hospitality of the visiting team
    2. Equipment charges
    3. 50% of the surgery fees
  4. THE SALE OR RENT OF EQUIPMENT: Once the training is complete the local facilities can either buy the equipment at each place or four of five places can share the equipment by paying per use as they did during the training period
  5. THE SALE OF DISPOSABLES AND HAND INSTRUMENTS: These would continue to provide regular income from the rural surgical facilities
  6. THE ANCILLARY INCOME: There is possibility of income from networking with volunteer groups and arranging for things like
    1. Working holidays program where voluntary work is combined with holidays at less know and virgin locations
    2. Ancillary course like medical media technology courses with plenty of practical work at new locations
Gnanaraj-64 Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision gasless laparoscopic surgeries. During the past year, he has been training surgeons in innovative gasless single incision laparoscopic surgeries.

References (click to show/hide)

  1. Available from:
  2. Roudakova K, Monga M. The evolving epidemiology of stone disease. Indian J Urol 2014;30:44-8
  3. J. Gnanaraj, Lau Xe Xiang Jason, Hanah Khiangte. High quality surgical care at low cost: The Diagnostic camp model of Burrows Memorial Christian Hospital Indian Journal of Surgery Vol. 69, No.6, December 2007 p 243-247.
  4. Available from:
  5. Available from:
  6. Available from:
  7. Available from:


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